Alcohol Withdrawl

Etiology

  • A syndrome of acute behavioral change associated with cessation of alcohol that occurs in some patients who chronically alcohol abuse
  • Cant predict solely on basis of abuse; documented history of prior withdrawal is useful for predicting future events.

Risk Factors

  • Alcohol abuse
  • Prior history of withdrawal

Symptoms

  • Spectrum of symptoms from mild agitation to profound delirium/seizures (a.k.a. Delirium Tremens)
  • Onset typically 24-72 hours after last drink (though can be earlier or later)
  • Initially mildly agitated/anxious, sweating
  • Nausea, vomiting
  • Can progresses to confusion, hallucinations (visual, auditory, tactile)
  • Can progress further to combative/wild behavior; and at far end of spectrum, generalized seizures (3-5% will have severe symptoms)
  • Can have similar symptoms with benzodiazapine withdrawal
  • Can also have symptoms from coingestions (e.g.narcotics, meth/stimulants, etc)

Physical Exam Findings

  • Tremor
  • Tachycardia, hypertension, sometime febrile
  • Difficult to keep focused, inattentive
  • Can range from mildly confused/disoriented to profound hallucinations, agitation, seizures